MEDICARE: PENSLOW HEALTH CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093813842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENSLOW HEALTH CLINIC INC

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445
Country	:	US
Telephone Number	:	910-329-7591
Fax Number	:	910-329-1592

Provider Business Practice Location Address
First Line	:	206 N DYSON ST
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445
Country	:	US
Telephone Number	:	910-329-7591
Fax Number	:	910-329-1592

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. CHERYL B HINES
Credential	:
Telephone Number	:	910-329-7591

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/16/2008

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Directions to “PENSLOW HEALTH CLINIC INC ” Practice Location

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